Ultrasound guided injections of the wrist and hand - The Ultrasound Site

Ultrasound guided wrist and hand injections

The wrist and hand contain a number of very superficial musculoskeletal structures, with conditions that can often have local injection therapy considered as a treatment approach. This lends itself to accurate needle placement with ultrasound guidance. Here we discuss some of the more common approaches.


Ultrasound guided 1st CMC joint injection

Injections of the carpometacarpal joint are often less painful under ultrasound guidance and very effective. As with all techniques, patient positioning and comfort are key as you start to develop a standardised approach to performing this procedure. Hopefully you find the resources below helpful.


Ultrasound guided de quervains (1st extensor compartment) injection

Ultrasound guided injections of the 1st extensor compartment ensure correct steroid placement, and this is particularly important when there are two separate compartments for the APL and EPB tendons. This is also a common area for patients to experience subcutaneous fat atrophy and skin depigmentation with steroid injections so accurate placement of the needle can assist reducing this risk.


Ultrasound guided trigger finger / tenosynovitis injection

Trigger fingers can be very disabling and painful, and steroid injections tend to provide effective management. Here we outline how we approach this under ultrasound guidance. as with any technique, ensuring you keep your probe stationary in a long axis view of the flexor tendons whilst injecting is vital to ensure continuous needle visualisation. These tendons are not often that wide, so subtle movements either way can mean you will no longer see the needle.

Ultrasound guided radiocarpal joint injection

This technique is straightforwards and best performed with the patients forearm in pronation, over a bowl to allow the joint to flex slightly. Moving the wrist joint from flexion to extension can also help to visualise the joint recess before injecting. Utilise the landmark of Listers tubercle to standardise the approach you will take each time.


Ultrasound guided carpal tunnel injection

Injections of the carpal tunnel under ultrasound guidance can be technically challenging due to anatomical variations of the position of neurovascular structures. We tend to advocate a radial approach.


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